1.1                          A bill for an act 
  1.2             relating to health; regulating coverage; requiring a 
  1.3             health plan company to offer at least one 
  1.4             point-of-service option in each market in which it 
  1.5             operates; proposing coding for new law in Minnesota 
  1.6             Statutes, chapter 62Q. 
  1.7   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.8      Section 1.  [62Q.50] [POINT-OF-SERVICE OPTION.] 
  1.9      Subdivision 1.  [DEFINITION.] For purposes for this 
  1.10  section, "point-of-service option" means a health plan under 
  1.11  which the health plan company will reimburse an appropriately 
  1.12  licensed or registered provider for providing covered services 
  1.13  to an enrollee, without regard to whether the provider belongs 
  1.14  to a particular network and without regard to whether the 
  1.15  enrollee was referred to the provider by another provider.  
  1.16     Subd. 2.  [REQUIRED POINT-OF-SERVICE OPTION.] Each health 
  1.17  plan company operating in the small group or large group market 
  1.18  shall offer at least one point-of-service option in each such 
  1.19  market in which it operates. 
  1.20     Subd. 3.  [RATE APPROVAL.] The premium rates and cost 
  1.21  sharing requirements for each option must be submitted to the 
  1.22  commissioner of health or the commissioner of commerce as 
  1.23  required by law.  A health plan that includes lower enrollee 
  1.24  cost sharing for services provided by network providers than for 
  1.25  services provided by out-of-network providers, or lower enrollee 
  1.26  cost sharing for services provided with prior authorization or 
  2.1   second opinion than for services provided without prior 
  2.2   authorization or second opinion, qualifies as a point-of-service 
  2.3   option. 
  2.4      Subd. 4.  [EXEMPTION.] This section does not apply to a 
  2.5   health plan company with fewer than 50,000 enrollees, or to a 
  2.6   health plan company for which at least 50 percent of enrollees 
  2.7   are covered under the medical assistance, general assistance 
  2.8   medical care, or MinnesotaCare programs. 
  2.9      Sec. 2.  [EFFECTIVE DATE; APPLICATION.] 
  2.10     Section 1 is effective August 1, 1996, and applies to 
  2.11  health plans issued or renewed to provide coverage for Minnesota 
  2.12  residents on or after that date.